Is Total Knee Arthroplasty a Viable Treatment Option in Octogenarians with Advanced Osteoarthritis?

PURPOSE: This study directly compared clinical assessment scores and short-term systemic complications after total knee arthroplasty (TKA) between a group of patients aged 80 or older (141 patients) and another group of patients aged between 65 and 70 years (616 patients) with advanced osteoarthritis. MATERIALS AND METHODS: We retrospectively investigated 757 osteoarthritic patients who underwent primary TKA from January 2007 to January 2011 with a follow-up of 1 year. The surgery was performed using an extramedullary alignment guide instrument without invasion of the intramedullary canal to decrease embolic load and blood loss. RESULTS: At 1 year after surgery, the mean Knee Society knee score was improved in both groups (from 63.6 to 83.2 in octogenarians and from 68.3 to 89.0 in the younger group) and the level of satisfaction was excellent in both groups (8 in octogenarians and 8.3 in the younger group), even though there was no notable change in function score in the octogenarians (from 61.0 to 61.9 in the octogenarians and from 62.3 to 73.6 in the younger group). The total incidence of systemic complications (3.4% vs. 1.2%, p=0.400) and surgical complications (2.1% vs. 0.5%, p=0.229) showed no significant difference between groups. CONCLUSIONS: TKA yielded favorable clinical outcomes with a comparatively low postoperative complication rate in octogenarians despite the negligible functional improvement.

How to Minimize Rotational Conflict between Femoral & Tibial Component in Total Knee Arthroplasty: The Use of Femoro-Tibial Axial Synchronizer (Linker)

PURPOSE: The purpose of this study was to investigate the correlation between rotational axes of femur and tibia with the use of Linker. MATERIALS AND METHODS: This study was carried out from August 2009 to February 2010 on 54 patients (106 knees), who were diagnosed with simultaneous bilateral total knee arthroplasty. With the use of postoperative computed tomography scans, it was investigated how much the rotational angle of femoral and tibial components matched. RESULTS: The tibial component was internally rotated for the femoral component at an angle of 0.8degrees. The femoral component was externally rotated for the surgical transepicondylar axis (TEA) at an angle of 1.6 (range: from 4.8degrees of internal rotation to 7.9degrees of external rotation, SD=2.2degrees), and the tibial component was externally rotated for the surgical TEA at an average angle of 0.9 (range: from 5.1degrees of internal rotation to 8.3degrees of external rotation, SD=3.1degrees). CONCLUSION: The femoro-tibial synchronizer helped to improve the orientation and positioning of both femoral component and tibial component, and also increase the correlation of the rotational axes of the two components.

How to Minimize Rotational Conflict between Femoral & Tibial Component in Total Knee Arthroplasty: The Use of Femoro-Tibial Axial Synchronizer (Linker)

PURPOSE: The purpose of this study was to investigate the correlation between rotational axes of femur and tibia with the use of Linker. MATERIALS AND METHODS: This study was carried out from August 2009 to February 2010 on 54 patients (106 knees), who were diagnosed with simultaneous bilateral total knee arthroplasty. With the use of postoperative computed tomography scans, it was investigated how much the rotational angle of femoral and tibial components matched. RESULTS: The tibial component was internally rotated for the femoral component at an angle of 0.8degrees. The femoral component was externally rotated for the surgical transepicondylar axis (TEA) at an angle of 1.6 (range: from 4.8degrees of internal rotation to 7.9degrees of external rotation, SD=2.2degrees), and the tibial component was externally rotated for the surgical TEA at an average angle of 0.9 (range: from 5.1degrees of internal rotation to 8.3degrees of external rotation, SD=3.1degrees). CONCLUSION: The femoro-tibial synchronizer helped to improve the orientation and positioning of both femoral component and tibial component, and also increase the correlation of the rotational axes of the two components.

Soft Tissue Balancing of Varus Arthritic Knee in Minimally Invasive Surgery Total Knee Arthroplasty: Comparison between Posterior Oblique Ligament Release and Superficial MCL Release

PURPOSE: To assess proper soft tissue balancing of the varus arthritic knee between posterior oblique ligament (POL) release group and superficial medial collateral ligament (SMCL) release group. MATERIALS AND METHODS: This retrospective study was performed on 186 patients who underwent minimally invasive surgery (MIS) total knee arthroplasty (TKA) from January 2011 to December 2011. Eighty-three patients were in the group of SMCL release and 103 patients were in the POL release group. We intended to use a 10 mm polyethylene insert (PE) during TKA, and retrospectively compared the actual thickness of PE between POL release group and SMCL release group. RESULTS: The mean PE thickness was 10.59+/-1.3 mm (range, 8 to 15 mm) in POL group and 11.88+/-1.8 mm (range, 10 to 18 mm) in SMCL group (p=0.001). We found a significant difference in the mean PE thickness between POL release group and SMCL release group. CONCLUSIONS: POL and deep MCL releases in MIS-TKA would be beneficial for varus deformity correction in the osteoarthritic knee.

Clinical Outcome of IM-Guided Total Knee Arthroplasty with Inappropriate Femoral Resection in Coronal Plane

PURPOSE: The purpose of this study was to evaluate clinical results and accuracy of femoral cutting in the coronal plane in total knee arthroplasty (TKA) using a fixed length intramedullary guide. MATERIALS AND METHODS: From 2005 to 2008, 101 patients (154 knees) underwent TKA (NexGen LPS implant). The minimal follow-up period was 3 years (mean, 4.4 years). The patients were divided into two groups (group 1, 94alpha, 98 or =2degrees MAD was 65 in group 1 and 24 in group 2. The mean PTA, KSKS, and KSFS were 10.17degrees, 96.0, and 96.6, respectively, in group 1 and 11.58degrees, 84.5, and 85.5, respectively, in group 2. CONCLUSIONS: The percentage of coronal alignment outliers was relatively high (34 in 154 cases, 22%) after TKA using a fixed length intramedullary guide. However, there was no statistically significant intergroup difference in clinical results (KSKS, p=0.67; KSFS, p=0.56).

Factors Correlated with the Reducibility of Varus Deformity in Knee Osteoarthritis: An Analysis Using Navigation Guided TKA

BACKGROUND: We hypothesized that a number of clinical and radiologic parameters could influence the reducibility of varus deformity in total knee arthroplasty. The aim of this study was to identify the factors correlated with reducibility of varus deformity and predict more accurately the amount of medial soft tissue release required in varus deformity total knee arthroplasty. METHODS: One hundred forty-three knees with preoperative varus alignment and medial osteoarthritis were included in this retrospective study. The total knee arthroplasties were performed using a navigation system (OrthoPilot) by single surgeon. To assess varus deformity, the authors measured preoperative mechanical axis angles and valgus stress angles. Mechanical tibial angles, mechanical femoral angles, femoral osteophyte sizes, and tibial osteophyte sizes were measured. The Ahlback grading scale was applied for radiologic parameters, and clinical parameters (age, body mass index, sex, duration of pain, and preoperative range of motion) were documented. Correlations between these factors and preoperative valgus stress angle were analyzed. RESULTS: A negative correlation was found between preoperative mechanical axis angle and preoperative valgus stress angle (p < 0.01, r = -0.38), and a positive correlation was found between the preoperative mechanical tibial angle and preoperative valgus stress angle (p = 0.01, r = 0.19). CONCLUSIONS: The present study shows that preoperative varus deformity and proximal tibial vara (measured by preoperative mechanical axis angle and mechanical tibial angle, respectively) are correlated with reducibility of varus deformity (measured by preoperative valgus stress angle), and clinical parameters (age, range of motion, duration of pain and body mass index) and other radiologic parameters (osteophyte size, severity of osteoarthritis and angulation of distal femoral joint surface) were not significantly correlated with reducibility of varus deformity.

Easy Identification of Mechanical Axis during Total Knee Arthroplasty

PURPOSE: We devised an intraoperatively identifiable mechanical axis (IIMA) as a reference of alignment in total knee arthroplasty (TKA). MATERIALS AND METHODS: Between February 2010 and January 2011, primary TKAs were consecutively performed on 672 patients (1007 knees) using an IIMA as a reference in the coronal plane. RESULTS: The alignment of the lower extremity improved from a mean of 11.4+/-6.7degrees (-10.3-34.4degrees) of varus preop. to 0.7+/-3.5degrees (-5.2-8.6degrees) immediately after surgery. Mean alignment of the femoral component in the coronal plane was 89.3+/-2.3degrees (83.4-97.2degrees) postop. and mean alignment of the tibial component was 90.4+/-2.2degrees (85.1-94.2degrees) postop. CONCLUSION: This study showed that IIMA could be of considerable value as a new guider of alignment that is easily accessible and highly effective during total knee arthroplasty.

Augmentation with Transcortical Wiring of an Onlay-type Prosthesis for a Deficient Patella during Revision Total Knee Arthroplasty

The management of patellae with a severe bony deficiency during revision total knee arthroplasty is a challenging problem. However, using a technique of augmentation with transcortical wiring of an onlay-type prosthesis allowed the authors to revise a deficient patellae successfully. After making the decision to revise the existing patellar component, the procedure was found to be technically straightforward. Furthermore, the procedure does not require sophisticated instruments, only an onlay-type prosthesis, cement and wires. This technique entails fixing wires to the three pegs of the patellar component, passing the wires through drill holes in the anterior cortex and, after compression of a cemented prosthesis, augmenting the fixation by twisting the wires anteriorly. We believe that stable fixation and painless articulation will be obtained with the described technique for deficient patellae.

Short-term Follow-up of Posterior Cruciate Ligament-sacrificed Total Knee Arthroplasty Using a Mobile Polyethylene Insert: Navigation-aided Technique

PURPOSE: Recently, a mobile ultracongruent polyethylene insert was used to increase joint stability in the posterior cruciate ligament sacrificed total knee arthroplasty with non-posted mobile bearing. However, as yet there have been no reports about this implant. In this study, the clinical and radiological results of surgery using the implant were analyzed through a navigation system. MATERIALS AND METHODS: The subjects included 95 cases of 70 patients to whom the rotating tibial implant was applied after posterior cruciate ligament resection among the patients who underwent total knee arthroplasty from September 2006 to December 2008. The follow-up duration was at least 24 months, and 40 months on average. For clinical evaluation, the knee score and functional scores were measured preoperatively and at the time of final follow-up. With reference to a 5 mm joint line change measurement recorded by the navigation system, which can affect the clinical result, the comparison and evaluation were performed by dividing the subjects into group I (5 mm). Radiological evaluation was performed by measuring the angle of the mechanical axis of the lower extremities and the patella tilting angle preoperatively and at the time of final follow-up using plain radiographs. RESULTS: Seventy subjects (95 cases) were followed up for at least 24 months. According to the clinical results, the mean KSS knee score improved from a preoperative score of 43.4 to a final follow-up score of 90.6 (p<0.0001). In addition, the mean functional score improved from a preoperative score of 51 to a final follow-up score of 88.4 (p<0.0001). Finally, the mean joint line change, which can affect the clinical result, was 5.82 mm, ranging from -1 to 12 mm. The clinical and radiological evaluations were performed by dividing the subjects into two groups in relation to the reference value of 5 mm, but no significant difference was found. The mechanical axis angles of the lower extremities improved from the preoperative value of varus 10.01degrees to the final follow-up value of varus 1.89degrees, and the difference was significant (p<0.0001). The mean patella tilting angles were 8.8degrees and 9.3degrees, respectively, at the time before the operation and after the final follow-up; this difference was not significant (p=0.89). CONCLUSION: Good clinical and radiological results were observed after at least two years of follow-up subsequent to total knee arthroplasty, in which a rotating ultracongruent polyethylene insert was applied after posterior cruciate ligament resection using a navigation system.

Accuracy of Inter Femoral Head Center Distance Measurement and Evaluation for Coronal Alignment of Femoral Component during Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Alignment is an important factor in the long-term success of total knee arthroplasty. In the total knee arthroplasty, the conventional extramedullary femoral alignment system has significant error in femoral coronal alignment, since it is difficult to find the femoral head center and it is time consuming to determine during the operation. The purpose of our study was to evaluate the accuracy of the newly-designed marker system for extramedullary femoral alignment that uses radiologic distance between the 2 femoral head centers. MATERIALS AND METHODS: Between July 2008 and July 2009, 90 patients (100 knees) with knee osteoarthritis underwent total knee arthroplasty using the femoral extramedullary femoral guide system. We measured the distance between the femoral head centers using the radiologic picture archiving and communication system (PACS, General Electric, Milwaukee, WI) system preoperatively, then plastic rods and metal pegs were used to simulate the inter femoral head center distance. By placing the center of the plastic rod after marking the inter femoral head center distance on the central body line, we could trace the coronal mechanical axis. We measured the angle between the femoral mechanical axis and the femoral component in standing long leg antero-posterior radiograph to assess radiologically the accuracy of coronal alignment postoperatively. RESULTS: The average femoral length in the study group was 402.5+/-16.2 mm. The mean distance between the femoral head and the center of the marker was 49.6+/-17.9 mm. The average error in estimation of the distance between the femoral head center and the metal peg of the marker was 3.78+/-3.14 mm. The positional error in alignment was 1degrees or less in 90% and 2degrees or less in 100% of knees. The average angle of femoral component to femoral mechanical axis was 89.9+/-1.5degrees (range 84.4-93.6degrees). The coronal alignment of the femoral components was within 90degrees+/-3degrees in -96% of cases. CONCLUSION: Our results suggest that the clinical method reported here is a simple and reliable method to localize the center of the femoral head during total knee arthroplasty.

An Extramedullary Femoral Alignment System in Total Knee Arthroplasty Using the Inter-Femoral Head Center Distance / 대한정형외과학회잡지

PURPOSE: Total knee arthroplasty using the extramedullary technique for alignment has some difficulty for detecting the center of the femoral head intra-operatively. In this study we tried to evaluate the usefulness and accuracy of a newly developed Mechanical Axis Marker that synchronizes the center of the knee joint and femoral head with the mechanical axis for the distal femoral cutting and femoral prosthesis alignment. MATERIALS AND METHODS: Between October 2008 and January 2009, 255 knees in 156 patients underwent total knee arthroplasty. We measured the distance between each centers of the femoral head using the PACS system and we applied the distance to the newly developed Mechanical Axis Marker. Subsequently, we applied the new marker to patients to align the centers of knee, the femoral head and the marker in line with the mechanical axis intra-operatively. The accuracy of the marker was validated with C-arm fluoroscopy pre-operatively in 20 patients. Post-operatively we measured and analyzed the frontal femoral component angle to evaluate the coronal alignment of the femoral implant. The accuracy was rated as excellent when the alignment was 5degrees. RESULTS: The pre-operative validation study with the C-arm fluoroscopy showed that the distance between the femoral head center and the metal peg of the marker was within 5 mm in 95% of the patients, which implied acceptable accuracy. The average frontal femoral component angle against the mechanical axis was 89.0degrees+/-1.1 (range 86degrees-96.6degrees). The proportion of excellent, good, and poor alignments was 90.6% (231 cases), 8.6% (22 cases), and 0.8% (2 cases), respectively. The intraclass correlation coefficient between the two observers for the frontal femoral component angle was 0.972 which showed high concordance. CONCLUSION: Our results indicate that the extramedullary technique assisted by our new Mechanical Axis Marker can easily identify the center of femoral head and improve the accuracy of frontal femoral component alignment with the proper mechanical axis.

Short Term Results of Cruciate Retaining TypeMobile Bearing Total Knee Arthroplasty: Using a Navigation System

PURPOSE: We wanted to report the minimum 3 year follow-up clinical results of the patients who underwent navigation guided cruciate retaining mobile bearing total knee arthroplasty and to evaluate the radiological results for a consecutive series of patients. MATERIALS AND METHODS: Cruciate retaining mobile bearing total knee arthroplasties with using a navigation system were performed for 54 knees. The mean patient age was 65 years old (range: 51~76 years). The mean follow up period was 44 months (range: 36~61 months). The Knee Society Score (KSS) and range of motion (ROM) were evaluated for the preoperative and postoperative clinical assessments. We evaluated the alignment and the position of the implants by using plane radiographs for the radiological assessment, and we investigated the wear and loosening of implants in the same manner at the last follow-up exam. RESULTS: The knee score improved from 38 to 91 (p=0.001) and the functional score improved from 46 to 92 (p=0.001). The mean range of motion was also improved postoperatively. The radiological results of the coronal axis alignment of the lower extremity and the implant position were satisfactory in 98% of the cases. Periprostheic osteolysis occurred in 4 cases, but there were no clinically significant osteolysis seen on the follow-up radiographs. CONCLUSION: Soft tissue balancing and the accuracy of implantation are necessary when performing cruciate retaining mobile bearing total knee arthroplasty. For this type of implant, navigation is useful tool to perform total knee arthorplasty for insuring the accuracy of the surgical procedure.

Bony Landmarks for Determining the Mechanical Axis of the Femur in the Sagittal Plane during Total Knee Arthroplasty

BACKGROUND: There is no accepted landmark for the mechanical axis of the femoral axis in sagittal plane in conventional total knee arthroplasty. METHODS: As palpable anatomic landmarks of the femur, lateral epicondyle, and anterior margin of the greater trochanter were identified. The line connecting these two landmarks was defined as the "palpable sagittal axis". The mechanical axis of the femur was compared with the palpable sagittal axis and the distal femoral anterior cortex axis. These axes were also compared with sagittal bowing of the femur. RESULTS: The distal femoral anterior cortex axis and the palpable sagittal axis were flexed by 4.1degrees and 2.4degrees more than the sagittal mechanical axes, respectively (p < 0.05). However, the palpable sagittal axis was not correlated with sagittal bowing of the femur (Spearman's rs, 0.17; p = 0.14). CONCLUSIONS: The palpable sagittal axis showed a consistent relationship with the sagittal mechanical femoral axes regardless of the severity of the sagittal bowing of the femur.

Radiological Results and Assessment of Navigation-Guided Total Knee Arthroplasty

PURPOSE: To assess the accuracy of implantation by radiologic results of navigation-guided total knee arthroplasty and compare radiologic results with navigation data. MATERIALS AND METHODS: Between September 2004 and May 2007, total knee arthroplasties were performed in 105 knees using navigation system and radiological results(group A) were compared with navigation data(group B). All patients had standing long anteroposterior radiographs of the lower extremities and supine lateral views of the knees at 6 weeks postoperatively. Mechanical axis deviation, alpha, theta, beta, gamma and delta angles were measured. Excepting alpha and gamma angles since there were no corresponding results among navigation data, reliability analysis was done for 4 angles. RESULTS: Radiological alignment on coronal plane relating to long-term prognosis were satisfactory in 97%. In analysis for reliability, mechanical axis deviation, theta, beta and delta angles showed moderate agreement. CONCLUSION: Radiological results of navigation-guided total knee arthroplasty allowed proper alignment and showed moderate agreement with navigation data, and thus navigation system will help to predict the postoperative radiological results.

Influence of Posterior Tibial Slope on Stability after Total Knee Arthroplasty

PURPOSE: The purpose of this study was to compare the influence of posterior tibial slope on hyperextension deformities and anterior tibial translation between two types of total knee arthroplasty(TKA); posterior cruciate retaining(CR) and substituting(PS), which have different polyethylene conformity. MATERIALS AND METHODS: 109 consecutive primary TKAs using Nexgen(R)(Zimmer, Warsaw, IN) CR(n=60) and PS (n=49) type prostheses, performed from July 1995 to August 2005 were reviewed. Each group of CR and PS were divided into two categories according to the degree of posterior tibial slope; 0~5 degrees and more than 5 degrees. The amount of hyperextension deformities and anterior tibial translation measured at the immediate and postoperative 2 years radiographs were analyzed in each subdivided groups. RESULTS: The significant amount of hyperextension deformities(p<0.05) and anterior tibial translation(p<0.05) were noted in the CR group. The CR group with more than 5 degrees of posterior tibial slope was more prone to develop the hype- rextension deformities(p=0.003) and anterior tibial translation(p=0.007) compared with the group that has posterior tibial slope less than 5 degrees. But in the PS group, there was no significant difference related with hyperextension deformities (p =0.240) and anterior tibial translation(p=0.204) between the two groups. CONCLUSION: The posterior tibial slope more than 5 degrees resulted in increments of the hyperextension and anterior tibial translation in the CR TKA group than in the PS TKA group.

Comparison of the Radiological Results Between Linker-Guided and Navigation-Guided total Knee Arthroplasty

PURPOSE: To compare the accuracy of implantation by radiologic results between 3D Linker and navigation guided total knee arthroplasty. MATERIALS AND METHODS: Between February 2004 and April 2005, total knee arthroplasties were done in 25 knees with balanced gap-resection technique (group A) and 25 using kinematic navigation system(group B) by a single surgeon. All patients had standing long anteroposterior (AP) radiographs of the lower extremities and supine lateral radiographs of the knees at 6 weeks postoperatively. Mechanical axis deviation, alpha and beta, angles were measured on standing long leg AP views and alpha and beta angles on supine knee lateral views. Results were classified according to the deviation from the reference line and graded as excellent, good, and poor. The result was regarded as satisfactory when all five angles were excellent or good. RESULTS: The mean mechanical axis deviation was 1.11degrees in group A and 1.36degrees in group B and all were excellent in both groups. Regarding alpha.angles, 19 cases were excellent and, 6 good in group A and, 21 excellent and 4 good in group B. Regarding., angles, 22 cases were excellent and, 3 good in group A and, 23 excellent and 2 good in group B. Regarding.,, angles, 15 cases were excellent, 8 good and 2 poor in group A and, 15 excellent, 9 good, and 1 poor in group B. Regarding beta angles, 19 cases were excellent, 3 good and 3 poor in group A and, 23 excellent, and 2 poor in group B. There were no statistical differences between two groups in all five angles (p>0.05). An excellent implantation in all five angles was obtained in 28% in group A and 60% in group B (p0.05). CONCLUSION: Radiological results (mechanical axis and component angles) of total knee arthroplasty were satisfactory in 80% with balanced gap-resection technique and 84% with kinematic navigation system and showed no statistical difference.

A Comparison of Extramedullary and Intramedullary Femoral Component Alignment Guide Systems in TKA

PURPOSE: To compare a new extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for femoral component alignment in total knee arthroplasty(TKA). MATERIALS AND METHODS: From November 2004 to June 2005, a newly developed extramdullary technique was applied in 80 cases (EM group), which was compared to another 80cases (IM group) in which conventional intramedullary technique was used. Standing long leg anteroposterior (AP) radiographs were evaluated at postoperative 2 months to compare the alignment between the groups. And surgery time between two groups was compared. RESULTS: Femoral component alignment was 1.7+/-1.3degrees in EM group and 1.3+/-1.2degrees in IM group (p=0.025). Clinically acceptable femoral component alignment(<+/-3degrees) was achieved in 92% of EM group and 93% in IM group. The femoral component flexion angle was 3.9+/-2.3degrees delta in EM group and 5.5+/-2.7degrees delta in IM group (p<0.0001). The surgery time was 69+/-11.5 min in EM group and 68+/-11.7 min in IM group(p= 0.516). CONCLUSION: By using our EM technique, we could achieve a accurate alignment and similar surgery time compared with conventional IM technique, although it is not superior to IM technique. We think that our new extramedullary technique is a useful surgical method decreasing the complications of intramedullary canal injury.

Analysis of the Relationship between Posterior Cruciate Ligament Preservation and Femoral Component Sizein Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: How PCL preservation affects the selection of femoral component size in total knee arthroplasty. MATERIALS AND METHODS: One hundred and fifty-seven patients, two-hundred and twenty-two knees, underwent total knee arthroplasties with Scorpio(R). One hundred and eighteen knees underwent PCL-preserving procedures, and one-hundred and four knees underwent PCL-substituting procedures. For minimization of error, we performed soft tissue balancing and then bone cutting by a Linker system with certain posterior slope (< or = 3 degrees). We compared the sizes of the femoral components between the PCL-preserving and PCL-substituting procedures in order to determine how flexion gap differences affect femoral component sizes (Wilcoxon signed rank test). RESULTS: With a certain minimal posterior slope (< or = 3 degrees), the PCL-preservation procedure led to selection of a 2.4 mm smaller femoral component than the PCL substituting procedure (p<0.05). CONCLUSION: Selection of femoral component size was affected by PCL preservation, and the size of the femoral component was decreased in the PCL preservation group.

Bilateral Total Knee Arthroplasties: Comparison of Simultaneous, Sequential, Staged Knee Replacement

PURPOSE: To compare the clinical outcomes of bilateral total knee arthroplasty (TKA) performed simultaneously by two teams or sequentially by one team under a single anesthesia, with those of staged bilateral TKA performed during separate hospitalizations. MATERIALS AND METHODS: We retrospectively analyzed 83 patients (166 knees) who underwent bilateral TKA. Group I comprised 25 patients receiving simultaneous bilateral TKA. Group II comprised 31 patients receiving sequential bilateral TKA. Group III comprised 27 patients receiving staged bilateral TKA spaced an average of 8.9 weeks apart. Data including complication rate, length of hospital stay, and allogenic blood transfusion rate were evaluated. RESULTS: Complication rate for group I, II, and III was 12%, 19.4%, and 25.9%, respectively, but there was no significant difference. Allogenic blood transfusion rate was 28%, 29%, and 11.1%, respectively, but there was no significant difference. The average hospital stay was 8.4 days, 8.9 days, and 14.5 days, respectively, and group I and II showed significantly shorter hospitalization compared with group III. CONCLUSION: Simultaneous or sequential bilateral TKA is a safe and efficient procedure that can shorten hospital stay without increasing complication rate and allogenic blood transfusion rate, compared with staged bilateral TKA.

Analysis of the Need and Predictive Factors for Allotransfusion in Autotransfused TKA & Non-Autotransfused TKA

PURPOSE: Authors attempted to evaluate the efficacy of autotransfusion and analyzed the relationship between patient 's factors and need for postoperative allo-blood transfusion in total knee arthroplasty(TKA). MATERIALS AND METHODS: Retrospective analysis of 214 patients (Group A - unilateral TKA without autotransfusion, 103; Group B - unilateral TKA with autotransfusion, 111) was conducted. We tried to transfuse allogeneic blood to patients whose hemoglobin fell below 9g/dL or vital sign was unstable on postoperative day 1. The requirement of allogeneic blood for each group was compared and the relationship between patient 's factors and postoperative allo-transfusion was analyzed with multivariate logistic regression analysis. RESULTS: Only 12.6% of patients in Group B required allogeneic blood transfusion compared with 23.3% in group A after TKA. Multivariate analysis identified significant predictive factors of the need for banked blood transfusion; preoperative hemoglobin levels and usage of autotransfusion instrument. CONCLUSION: Use of allogeneic blood replacement in the group using autotransfusion instrument decreased significantly compared with the group that did not use autotransfusion. The factors associated with reducing the need for postoperative blood transfusion were usage of autotransfusion instrument and high preoperative hemoglobin levels in TKA.